Emergency services are self-referral, so does that mean that the 2-digit cert code is not needed?
This policy is the same as in Hoosier Healthwise. Q: Scenario for weekend outpatient services: A member will present on a Saturday or Sunday with a request for an X-Ray or some other outpatient procedure from their family practitioner. The member does not realize they have been auto-assigned to another physician, so we will call the PMP that Medicaid says is their PMP and the PMP will not authorize the service until he/she sees the patient. Because the member presented on a weekend, we provided the service and tried to get the authorization on the back-end. Is there anything that can be done in this type of situation? A: This policy is the same as in Hoosier Healthwise. Eligibility should be verified prior to rendering service to ascertain if the member is in managed care and whether PMP authorization of service is necessary. Please note that effective January 15, 2003, the cert code requirement for X-rays and a number of other ancillary services has been eliminated for both Hoosier He
Related Questions
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- Emergency services are self-referral, so does that mean that the 2-digit cert code is not needed?
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